Barriers and enablers to increasing the amount of practice completed by stroke survivors during inpatient rehabilitation

Abstract

Background: An evidence-practice gap exists between the amount of practice recommended in national guidelines, and the amount completed by stroke survivors during rehabilitation. To address this gap, a participatory, theoretically tailored behaviour change intervention has been designed to help staff increase use of practice books and weekend classes. Aim: To identify barriers and enablers to implementing practice books and nurse-led weekend classes, to increase practice by stroke inpatients. Methods: A qualitative design was used. Five multidisciplinary focus groups were held with 21 staff from one rehabilitation unit. Eleven nurses, 8 allied health professionals and 2 medical staff participated with an average time since qualification of 9 years (range 1.5-27.0). Observational data and case studies were presented during the focus groups. Focus group discussions were guided by the Theoretical Domains Framework (TDF). Data analysis was conducted using framework analysis and the TDF. Barriers were mapped to behaviour change interventions using the Behaviour Change Wheel framework. Results: Barriers identified included staff beliefs about patients' motivation to participate in rehabilitation and patient's perceptions of the nursing role. Other barriers included the ward environment, resources and staff ability to motivate, coach and supervise active practice. Enablers included staff beliefs about the importance of increasing active practice. The tailored staff behaviour change intervention included a training program on motivation, environmental restructuring and audit and feedback. Conclusions: We have obtained valuable data enabling the design of a theoretically tailored behaviour change intervention. Barriers were consistent with those reported in previous studies, helping to increase generalisability.L617955267 <br />